Browsing by Author "Martin, Fernando"

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    Resurgimiento de la artroplastia total de rodilla no cementada: revisión narrativa
    (2025) Calvo, Rafael; Martin, Fernando; Riquelme, Juan; Partarrieu, Robert; Edwards, Diego; Figueroa, David
    Objetivo Analizar el resurgimiento, las indicaciones actuales y los resultados clínicos de la artroplastia total de rodilla (ATR) no cementada en la era moderna. Materiales y Métodos Se realizó una revisión narrativa de la literatura (de 2010 a 2025) que incluyó datos de registros de artroplastias de los Estados Unidos y del Reino Unido (el American Joint Replacement Registry [AJRR] y el National Joint Registry [NJR]), revisiones sistemáticas y estudios clínicos comparativos. Se evaluaron aspectos como diseño de implantes, biología de la fijación, supervivencia a mediano y largo plazos, costo-efectividad y controversias actuales. Resultados Los registros nacionales y la evidencia de nivel I indican que los implantes no cementados modernos, con recubrimientos de alta porosidad, alcanzan tasas de supervivencia comparables a las de la técnica cementada a mediano plazo. Las indicaciones se han expandido, lo que demuestra seguridad en pacientes mayores de 75 años, obesos (Índice de Masa Corporal [IMC] ≥ 35 kg/m²) y aquellos con patologías asociadas. Discusión Si bien la fijación biológica ofrece ventajas como la preservación de stock óseo y la reducción del tiempo quirúrgico, persisten controversias respecto al manejo del componente patelar y la curva de aprendizaje para lograr una estabilidad primaria (press-fit) adecuada sin complicaciones. Conclusión La ATR no cementada contemporánea es una alternativa segura y eficaz, con resultados clínicos equivalentes a los de la fijación cementada. Aunque su uso se ha validado en diversos grupos de pacientes, la técnica cementada permanece como el estándar de referencia hasta que se confirme su superioridad biológica a largo plazo. Objective To analyze the resurgence, current indications, and clinical outcomes of cementless total knee arthroplasty (TKA) in the modern era. Materials and Methods We conducted a narrative review of the literature (from 2010 to 2025) including data from the United States and United Kingdom arthroplasty registries (the American Joint Replacement Registry [AJRR] and the National Joint Registry [NJR]), systematic reviews, and comparative clinical studies. Aspects such as implant design, fixation biology, medium- and long-term survival, cost-effectiveness, and current controversies were evaluated. Results The national registries and level-I evidence indicate that modern cementless implants, with high-porosity coatings, yield survival rates comparable to those of the cemented technique in the medium term. The indications have expanded, demonstrating safety in patients older than 75 years of age, obese subjects (Body Mass Index [BMI] ≥ 35 kg/m²), and those with associated pathologies. Discussion Although biological fixation offers advantages such as bone-stock preservation and reduced operative time, controversies persist regarding patellar component management and the learning curve to achieve adequate primary stability (press-fit) without complications. Conclusion Contemporary cementless TKA is a safe and effective alternative, with clinical outcomes equivalent to those of cemented fixation. Although its use has been validated in various patient groups, the cemented technique remains the reference standard until its long-term biological superiority is confirmed.
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    Publication
    Return to sports and recreational activities after patellofemoral arthroplasty: A systematic review
    (2025) Arteaga, José; Poblete, Eduardo; Martin, Fernando; Domecq, Gabriel; Figueroa, David
    Importance: Patellofemoral arthroplasty (PFA) is an established treatment for isolated patellofemoral osteoarthritis. However, evidence regarding postoperative activity levels and return to sport (RTS) remains limited. Objective: The objective of this study was to evaluate RTS and recreational activity rates following PFA, identify factors influencing these outcomes, and report associated complications. Evidence review: A systematic search was conducted in June 2024 across PubMed, EMBASE, ScienceDirect, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included variations of “patellofemoral arthroplasty,” “physical activity,” and “return to sport.” Studies were included if they reported RTS outcomes following PFA. Studies lacking RTS data or isolated PFA results were excluded. From 492 records, 7 studies met the inclusion criteria. Findings: Seven studies (2 prospective and 5 retrospective) comprising 265 patients (281 knees; 64.6% women; mean age: 48.9 years) were included, with a mean follow-up of up to 5.3 years. RTS definitions varied, with reported rates ranging from 64.7% to 91%. Low-impact sports were more commonly resumed, and 58.6% of patients returned to sport within six months. Among those who returned, 74.8% reached or exceeded their preoperative activity level. Postoperative pain improved (visual analog scale scores decreased from 6.3 to 2.7), although up to 38.6% of patients reported pain limiting activity. Conversion to total knee arthroplasty occurred in 6.3% to 13% of cases, and reoperation rates ranged from 10.4% to 25%. Limitations included inconsistent RTS definitions, heterogeneous outcome reporting, and use of non-standardized questionnaires. Conclusions: RTS and recreational activity after PFA can be resumed by most patients, especially low-impact activities. Pain management should be actively addressed. High-quality studies with standardized RTS definitions are needed to evaluate the long-term impact of activity on implant survival. Relevance: RTS after PFA is safe and achievable. A personalized approach is essential to optimize RTS and manage patient expectations. Evidence level: III.

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